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The persisting outbreak of SARS-CoV-2 has posed an enormous threat to global health. The sustained human-to-human transmission of SARS-CoV-2 via respiratory droplets makes the medical procedures around the perioral area vulnerable to the spread of the disease. Such procedures include the ultrasonic dental cleaning method, which occurs within the oral cavity and involves cavitation-induced sprays, thus increasing the risk of pathogen transmission via advection. To understand the associated health and safety risks for patients and clinicians, it is critical to understand the flow pattern of the spray cloud around the operating region, the size and velocity distribution of the emitted droplets, and the extent of fluid dispersion until ultimate deposit on surfaces or escape through air vents. In this work, the droplet size and velocity distributions of the spray emerging from the tip of a free-standing common ultrasonic dental cleaning device were characterized via high-speed imaging. Deionized water and 1.5% and 3% aqueous hydrogen peroxide (H2O2) solutions were used as working fluids, with the H2O2—an established oxidizing agent—intended to curb the survival of virus released in aerosols generated from dental procedures. The measurements reveal that the presence of H2O2 in the working fluid increases the mean droplet size and ejection velocity. Detailed computational fluid dynamic simulations with multiphase flow models reveal benefits of adding small amounts of H2O2 in the feed stream of the ultrasonic cleaner; this practice causes larger droplets with shorter residence times inside the clinic before settling down or escaping through air vents. The results suggest optimal benefits (in terms of fluid spread) of adding 1.5% H2O2 in the feed stream during dental procedures involving ultrasonic tools. The present findings are not specific to the COVID-19 pandemic but should also apply to future outbreaks caused by airborne droplet transmission.

INTRODUCTION: Evidence suggests that United States (US) dentists excessively prescribe opioids. There are limited national data on recent trends in opioid prescribing by US dentists. This study examined trends of opioid prescribing by general dentists and dental specialists in the US from 2012–2019. METHODS: Dispensed prescriptions for oral opioid analgesics written by dentists were identified in the IQVIA Longitudinal Prescription Dataset from January 2012 through December 2019. Autoregressive integrated moving average and joinpoint regression models described monthly population-based prescribing rates (prescriptions [Rx]/100,000 persons), dentist-based prescribing rates (Rx/1,000 dentists), and opioid dosages (mean daily morphine milligram equivalents [MME/day]). All analyses were performed in 2020. RESULTS: Over the eight years, dentists prescribed >87.2 million opioid prescriptions. Population- and dentist-based prescribing rates declined monthly by −1.97 Rx/100,000 persons (95% confidence intervals [CI] −9.98, −0.97) and −39.12 Rx/1,000 dentists (95%CI −58.63, −17.65), respectively. Opioid dosages declined monthly by −0.08MME/day (95%CI −0.13,−0.04). Joinpoint regression identified four time-points (February 2016, May 2017, December 2018, and March 2019) at which monthly prescribing rate trends were often decreasing in greater magnitude compared to the prior time-segment. CONCLUSION: Following national trends, dentists became more conservative in prescribing opioids. Greater magnitude of decline occurred post-2016, following the implementation of strategies aimed to further regulate opioid prescribing. Understanding factors that influence prescribing trends can aid in development of tailored resources to encourage and support dentists’ conservative approach to prescribing opioids.

Prescribing antibiotic prophylaxis is common yet unnecessary for many dental visits. In this analysis, our objective was to assess whether the appropriateness of antibiotic prophylaxis has improved over time.A retrospective cohort study was conducted using dental visits from 2016 to 2018 (data analyzed in 2021) using medical and prescriptions claims data of patients from the U.S. with commercial dental insurance. Antibiotic prophylaxis was defined as a ≤2 days' supply prescription dispensed within 7 days before a dental visit. Appropriateness of prophylaxis was defined on the basis of the manipulation of the gingiva/tooth periapex or oral mucosa perforation in patients with appropriate cardiac diagnoses. Associations between patient and visit characteristics and appropriateness of antibiotic prophylaxis were assessed using multiple Poisson regression.Unnecessary antibiotic prophylaxis was highly prevalent in this cohort, ranging from 77.0% in 2016 to 78.5% in 2018. In the adjusted analysis, factors associated with unnecessary antibiotic prophylaxis included younger age, female sex, geographic region, rurality, type of antibiotic, and certain dental procedures. The factors associated with the highest risk of unnecessary prophylaxis in the adjusted analysis were orthodontic procedures and having a history of a prosthetic joint. Notably, the risk of unnecessary antibiotic prophylaxis decreased over time in the adjusted analysis.Unnecessary prescription of antibiotic prophylaxis by dentists continues to be common. Antimicrobial stewardship strategies are needed to improve prescribing by dentists.

Dentists in the United States frequently prescribe opioids for dental-related pain, although evidence shows superior efficacy of nonopioids for pain management. A national sample of US dentists was interviewed to understand the barriers and facilitators to opioid prescribing.Semistructured one-on-one telephone interviews were conducted with dentists sampled from the 6 regions of The National Dental Practice-Based Research Network. Responses were coded into the domains of the Capability, Opportunity and Motivation Model of Behavior. Potential behavior change interventions were identified for targeted themes.Seventy-three interviews were qualitatively analyzed. Most of those interviewed were general dentists (86.3%) and on average (SD) were in practice for 24.3 (13.0) years. Ten themes were identified within the Capability, Opportunity and Motivation Model of Behavior. Dentists' knowledge of opioid risk, ability to identify substance use disorder behavior, and capability of communicating pain management plans to patients or following clinic policies or state and federal regulations were linked with judicious opioid prescribing. Dentists reported prescribing opioids if they determined clinical necessity or feared negative consequences for refusing to prescribe opioids.Dentists' opioid decision making is influenced by a range of real-world practice experiences and patient and clinic factors. Education and training that target dentists' knowledge gaps and changes in dentists' practice environment can encourage effective communication of pain management strategies with patients and prescribing of nonopioids as first-line analgesics while conserving opioid use.Identified knowledge gaps in dentistry can be targets for education, clinical guidelines, and policy interventions to ensure safe and appropriate prescribing of opioids.

Graphical abstract Throughout 2020 and beyond, the entire world has observed a continuous increase in the infectious spread of the novel coronavirus (SARS-CoV-2) otherwise known as COVID-19. The high transmission of this airborne virus has raised countless concerns regarding safety measures employed in the working conditions for medical professionals. Specifically, those who perform treatment procedures on patients which intrinsically create mists of fine airborne droplets, i.e., perfect vectors for this and other viruses to spread. The present study focuses on understanding the splatter produced due to a common dentistry technique to remove plaque buildup on teeth. This technique uses a high-speed dentistry instrument, e.g., a Cavitron ultrasonic scaler, to scrape along the surface of a patient’s teeth. This detailed understanding of the velocity and the trajectory of the droplets generated by the splatter will aid in the development of hygiene mechanisms to guarantee the safety of those performing these procedures and people in clinics or hospitals. Optical flow tracking velocimetry (OFTV) method was employed to obtain droplet velocity and trajectory in a two-dimensional plane. Multiple data collection planes were taken in different orientations around a model of adult mandibular teeth. This technique provided pseudo-three-dimensional velocity information for the droplets within the splatter developed from this high-speed dental instrument. These results indicated that within the three-dimensional splatter produced there were high velocities (1–2 m/s) observed directly below the intersection point between the front teeth and the scaler. The splatter formed a cone-shape structure that propagated 10–15 mm away from the location of the scaler tip. From the droplet trajectories, it was observed that high velocity isolated droplets propagate away from the bulk of the splatter. It is these droplets which are concerning for health safety to those performing the medical procedures. Using a shadowgraphy technique, we further characterize the individual droplets’ size and their individual velocity. We then compare these results to previously published distributions. The obtained data can be used as a first step to further examine flow and transport of droplets in clinics/dental offices.

Dentists prescribe 10% of outpatient antibiotics in the USA; we discuss recent data evaluating antibiotic use in dentistry and opportunities for improvement. We review the indications for antibiotics in dentistry, recent data highlighting frequent unnecessary use of antibiotic prophylaxis prior to dental procedures, adverse effects associated with antibiotic use in dentistry, and examples of successful stewardship interventions in the dental setting. Antimicrobial stewardship in dentistry is nascent and current data suggest antibiotic use can be significantly improved in this setting which may lead to improved patient outcomes and decreased risk of adverse drug effects.

COVID-19, caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus, has been rapidly spreading worldwide since December 2019, causing a public health crisis. Recent studies showed SARS-CoV-2's ability to infect humans via airborne routes. These motivated the study of aerosol and airborne droplet transmission in a variety of settings. This study performs a large-scale numerical simulation of a real-world dentistry clinic that contains aerosol-generating procedures. The simulation tracks the dispersion of evaporating droplets emitted during ultrasonic dental scaling procedures. The simulation considers 25 patient treatment cubicles in an open plan dentistry clinic. The droplets are modeled as having a volatile (evaporating) and nonvolatile fraction composed of virions, saliva, and impurities from the irrigant water supply. The simulated clinic's boundary and flow conditions are validated against experimental measurements of the real clinic. The results evaluate the behavior of large droplets and aerosols. We investigate droplet residence time and travel distance for different droplet diameters, surface contamination due to droplet settling and deposition, airborne aerosol mass concentration, and the quantity of droplets that escape through ventilation. The simulation results raise concerns due to the aerosols' long residence times (averaging up to 7.31 min) and travel distances (averaging up to 24.45 m) that exceed social distancing guidelines. Finally, the results show that contamination extends beyond the immediate patient treatment areas, requiring additional surface disinfection in the clinic. The results presented in this research may be used to establish safer dental clinic operating procedures, especially if paired with future supplementary material concerning the aerosol viral load generated by ultrasonic scaling and the viral load thresholds required to infect humans.

BACKGROUND Opioid prescribing by dentists for older patients receiving medications with potential contraindications and the subsequent impact on acute care outcomes is not well described. OBJECTIVES Our objective of this paper was to evaluate the use of potentially inappropriate medication combinations (PIMCs) involving opioids prescribed by dentists according to the Beers Criteria and risks of 30-day emergency department (ED) visits and all-cause hospitalization among commercially insured dental patients ages 65 years and older. METHODS We conducted a retrospective cohort study of 40,800 older dental patient visits in which opioids were prescribed between 2011 and 2015 using the IBM MarketScan databases. Data collection from dental, medical, and pharmacy claims included information on the concurrent use of PIMCs and outcomes of all-cause acute care utilization over the 30-day period after dental encounters. RESULTS For the overall cohort, the median age was 69 years, and 45% were women. The prevalence of PIMCs per Beers Criteria was 10.4%. A total of 947 all-cause acute care events were observed in the 30 days post-dental visit. Patients with PIMCs involving opioids prescribed by dentists according to the Beers Criteria had higher rates of acute care use (3.3% vs 2.2%, p

INTRODUCTION: The objective of this study was to identify county-level characteristics that may be high impact targets for opioid and antibiotic interventions to improve dental prescribing. METHODS: Prescriptions during 2012–2017 were extracted from IQVIA LRx. Primary outcomes were yearly county-level antibiotic and opioid prescribing rates. Multivariable negative binomial regression identified associations between prescribing rates and county-level characteristics. All analyses occurred in 2020. RESULTS: Over time, dental opioid prescribing rates decreased by 20% (4.02 to 3.22/100 persons), while antibiotic rates increased by 5% (6.85 to 7.19/100 persons). Higher number of dentists per capita, higher proportion of female residents, and higher proportion of residents less than 65 years old were associated with increased opioid rates. Relative to the West, location in the Northeast (59%, 95% CI, 52%−65%) and Midwest (64%, 95% CI, 60%−70%) was associated with lower opioid prescribing rates. Higher clinician density, median household income, proportion female, and proportion white were all independently associated with higher antibiotic rates. Location in the Northeast (149%, 95% CI, 137%−162%) and Midwest (118%, 95% CI, 111%−125%) was associated with higher antibiotic rates. Opioid and antibiotic prescribing rates were positively associated. CONCLUSIONS: Dental prescribing of opioids are decreasing while dental antibiotic prescribing are increasing. High prescribing of antibiotics was associated with high prescribing of opioids. Strategies focused on optimizing dental antibiotics and opioids is needed given their impact on population health.

Background Gaining a better understanding of dental prescribing can help identify opportunities for intervention regarding optimal medication use. The purpose of this study is to characterize opioid and antibiotic prescribing patterns of dentists in the United States for Medicare Part D beneficiaries. Methods The authors conducted a retrospective cross-sectional analysis of national 2014 Medicare Part D Prescriber Public Use File data. Providers in the data set with dental-related disciplines were included (n = 99,797). Outcomes of interest were mean days’ supply and mean number of claims reported per claim, beneficiary, and prescriber discipline. Results Of the 6,724,372 dental prescription claims submitted, 3,947,848 (58.7%) and 1,312,796 (19.5%) were for antibiotics and opioids, respectively. Sixty-nine percent of dentists in the highest quartile of opioid prescribers were also in the highest quartile of antibiotic prescribers (r2 = 0.7778; P Conclusion Opioids and antibiotics are the medications most prescribed by dentists. On the basis of national recommendations and results of studies from other countries, the length of therapy prescribed may be excessive. Further studies should be conducted to assess appropriateness of dental prescriptions. Practical Implications Dentistry should be considered for antibiotic and opioid stewardship interventions along with medicine.

Student evaluation of teaching (SET) is often used in the assessment of faculty members' job performance and promotion and tenure decisions, but debate over this use of student evaluations has centered on the validity, reliability, and application of the data in assessing teaching performance. Additionally, the fear of student criticism has the potential of influencing course content delivery and testing measures. This Point/Counterpoint article reviews the potential utility of and controversy surrounding the use of SETs in the formal assessment of dental school faculty. Viewpoint 1 supports the view that SETs are reliable and should be included in those formal assessments. Proponents of this opinion contend that SETs serve to measure a school's effectiveness in support of its core mission, are valid measures based on feedback from the recipients of educational delivery, and provide formative feedback to improve faculty accountability to the institution. Viewpoint 2 argues that SETs should not be used for promotion and tenure decisions, asserting that higher SET ratings do not correlate with improved student learning. The advocates of this viewpoint contend that faculty members may be influenced to focus on student satisfaction rather than pedagogy, resulting in grade inflation. They also argue that SETs are prone to gender and racial biases and that SET results are frequently misinterpreted by administrators. Low response rates and monotonic response patterns are other factors that compromise the reliability of SETs.

Introduction Dentists prescribe 1 in 10 opioid prescriptions in the U.S. When opioids are necessary, national guidelines recommend the prescription of low-dose opioids for a short duration. This study assesses the appropriate prescribing of opioids by dentists before guideline implementation. Methods The authors performed a cross-sectional analysis of a population-based sample of 542,958 U.S. commercial dental patient visits between 2011 and 2015 within the Truven Health MarketScan Research Databases (data analysis October 2018‒April 2019). Patients with recent hospitalization, active cancer treatment, or chronic pain conditions were excluded. Prescription opioids were ascertained using pharmacy claims data with standardized morphine equivalents and recorded days’ supply. Appropriate prescribing was determined from the 2016 Centers for Disease Control and Prevention guidelines for pain management based on a recommended 3 days’ supply of opioid medication and anticipated post-procedural pain. Results Twenty-nine percent of prescribed opioids exceeded the recommended morphine equivalents for appropriate management of acute pain. Approximately half (53%) exceeded the recommended days’ supply. Patients aged 18–34 years, men, patients residing in the Southern U.S., and those receiving oxycodone were most likely to have opioids prescribed inappropriately. The proportion of opioids that exceed the recommended morphine equivalents increased over the study period, whereas opioids exceeding the recommended days’ supply remained unchanged. Conclusions Between 1 in 4 and 1 in 2 opioids prescribed to adult dental patients are overprescribed. Judicious opioid-prescribing interventions should be tailored to oral health conditions and dentists.

Key Points Question Are antibiotics appropriately prescribed for infection prophylaxis before dental procedures? Findings In this cohort study of 91 438 patients who received antibiotic prophylaxis for 168 420 dental visits from 2011 to 2015, a total of 90.7% of dental visits had manipulation of the gingiva or tooth periapex, but only 20.9% of patients had a cardiac condition at the highest risk of adverse outcome from infective endocarditis. Therefore, 80.9% of antibiotic prophylaxis prescriptions were discordant with guidelines. Meaning Most antibiotics prescribed for infection prophylaxis before dental procedures are unnecessary., This cohort study assesses the appropriateness of antibiotic prophylaxis prescriptions for infection prophylaxis before dental procedures using Truven, a US national integrated health claims database., Importance Antibiotics are recommended before certain dental procedures in patients with select comorbidities to prevent serious distant site infections. Objective To assess the appropriateness of antibiotic prophylaxis before dental procedures using Truven, a national integrated health claims database. Design, Setting, and Participants Retrospective cohort study. Dental visits from 2011 to 2015 were linked to medical and prescription claims from 2009 to 2015. The dates of analysis were August 2018 to January 2019. Participants were US patients with commercial dental insurance without a hospitalization or extraoral infection 14 days before antibiotic prophylaxis (defined as a prescription with ≤2 days’ supply dispensed within 7 days before a dental visit). Exposures Presence or absence of cardiac diagnoses and dental procedures that manipulated the gingiva or tooth periapex. Main Outcomes and Measures Appropriate antibiotic prophylaxis was defined as a prescription dispensed before a dental visit with a procedure that manipulated the gingiva or tooth periapex in patients with an appropriate cardiac diagnosis. To assess associations between patient or dental visit characteristics and appropriate antibiotic prophylaxis, multivariable logistic regression was used. A priori hypothesis tests were performed with an α level of .05. Results From 2011 to 2015, antibiotic prophylaxis was prescribed for 168 420 dental visits for 91 438 patients (median age, 63 years; interquartile range, 55-72 years; 57.2% female). Overall, these 168 420 dental visits were associated with 287 029 dental procedure codes (range, 1-14 per visit). Most dental visits were classified as diagnostic (70.2%) and/or preventive (58.8%). In 90.7% of dental visits, a procedure was performed that would necessitate antibiotic prophylaxis in high-risk cardiac patients. Prevalent comorbidities include prosthetic joint devices (42.5%) and cardiac conditions at the highest risk of adverse outcome from infective endocarditis (20.9%). Per guidelines, 80.9% of antibiotic prophylaxis prescriptions before dental visits were unnecessary. Clindamycin was more likely to be unnecessary relative to amoxicillin (odds ratio [OR], 1.10; 95% CI, 1.05-1.15). Prosthetic joint devices (OR, 2.31; 95% CI, 2.22-2.41), tooth implant procedures (OR, 1.66; 95% CI, 1.45-1.89), female sex (OR, 1.21; 95% CI, 1.17-1.25), and visits occurring in the western United States (OR, 1.15; 95% CI, 1.06-1.25) were associated with unnecessary antibiotic prophylaxis. Conclusion and Relevance More than 80% of antibiotics prescribed for infection prophylaxis before dental visits were unnecessary. Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.

BackgroundMost antibiotic use in the United States occurs in the outpatient setting, and 10% of these prescriptions are generated by dentists. The development of comprehensive antibiotic stewardship programs (ASPs) in the dental setting is nascent, and therefore we describe the implementation of a dental ASP.MethodsA collaborative team of dentist, pharmacist, and physician leaders conducted a baseline needs assessment and literature evaluation to identify opportunities to improve antibiotic prescribing by dentists within Illinois’ largest oral health care provider for Medicaid recipients. A multimodal intervention was implemented that included patient and provider education, clinical guideline development, and an assessment of the antibiotic prescribing rate per urgent care visit before and after the educational interventions.ResultsWe identified multiple needs, including standardization of antibiotic prescribing practices for patients with acute oral infections in the urgent care clinics. A 72.9% decrease in antibiotic prescribing was observed in urgent care visits after implementation of our multimodal intervention (preintervention urgent care prescribing rate, 8.5% [24/283]; postintervention, 2.3% [8/352]; P < .001).ConclusionsWe report the successful implementation of a dental ASP that is concordant with the Centers for Disease Control and Prevention Core Elements of Antibiotic Stewardship in the Outpatient Setting. Our approach may be adapted to other dental practices to improve antibiotic prescribing.

Background Data suggest dental antibiotic prescribing is increasing with relatively less documented about prescribing trends in adults and children. Therefore, the aim was to evaluate trends in antibiotic prescribing by US dentists from 2012–2017. Methods This was a cross-sectional study of US dental prescribing using IQVIA Longitudinal Prescription Data from 2012 to 2017. Prescribing rates (prescriptions [Rx] per 100,000 dentists), mean days’ supply, and mean quantity dispensed were calculated monthly across eight oral antibiotic groups: amoxicillin, clindamycin, cephalexin, azithromycin, penicillin, doxycycline, fluoroquinolone, and other antibiotics. Descriptive frequencies and multiple linear regressions were performed to obtain trends overall and stratified by adults (≥ 18) and children (< 18). Results 220, 325 dentists prescribed 135 million Rx (94.0% in adults). 61.0% were amoxicillin, 14.4% clindamycin, 11.7% penicillin, 4.4% azithromycin, 4.3% cephalexin, 2.0% other antibiotics, 1.4% doxycycline, and 0.7% fluoroquinolones. Prescribing increased by 33 Rx/100,000 dentists (p< 0.0001) each month for all antibiotics. Amoxicillin (p< 0.0001) and clindamycin (p=0.02) prescribing rate increased by 73 and 5 Rx/100,000 dentists, respectively. Prescribing decreased by 8, 12, and 2 Rx/100,000 dentists for cephalexin (p< 0.0001), doxycycline (p< 0.0001), and fluoroquinolones (p=0.008), respectively. Mean days’ supply increased for amoxicillin, penicillin, and clindamycin (p< 0.0001), and decreased for cephalexin (p< 0.0001).Mean quantity dispensed decreased (p< 0.0001) for all groups except azithromycin and doxycycline. Among adults, cephalexin prescribing rates (7 Rx/100,000 dentist; p< 0.0001) and other antibiotics days’ supply (p< 0.0001) decreased. Among children, azithromycin prescribing rates (1 Rx/100,000 dentists, p=0.02), and fluoroquinolone and other antibiotics days’ supply (p< 0.0001) decreased. Conclusion These findings support dental antibiotic prescribing is increasing, specifically for amoxicillin and clindamycin. Further, trends differed between adults and children. Understanding what is driving these trends is important to target dental antibiotic stewardship efforts. Disclosures All Authors: No reported disclosures

Background Dentists prescribe 10% of outpatient antibiotics in the United States, with a significant portion of these being for prophylaxis. We previously found that 80% of prescriptions for prophylaxis prescribed prior to dental visits are unnecessary; however, the sequelae of these unnecessary antibiotics have not been characterized. Our objective was to assess the harms of unnecessary antibiotic prophylaxis using Truven, a national health claims database. Methods This was a retrospective cohort study of patients with dental visits from 2011 to 2015 linked to medical and prescription claims. Patients with commercial dental insurance without a hospitalization or extra-oral infection 14 days prior to antibiotic prophylaxis (≤2 days supply dispensed within 7 days before a dental visit) were assessed for inclusion. Patients with unnecessary antibiotic prophylaxis (defined as antibiotic prophylaxis in patients who both did not undergo a procedure that manipulated the gingiva/tooth periapex and did not have an appropriate cardiac diagnosis) were included and assessed for serious antibiotic-related adverse effects (AAE). The primary endpoint was the cumulative incidence of any AAE within 14 days post-prescription (composite of allergy, anaphylaxis, C. difficile infection, or ED visit). The secondary analyses were the cumulative incidence of each individual AAE and the risk difference of the primary endpoint between amoxicillin and clindamycin. Results Of the 168,420 dental visits with antibiotic prophylaxis, 136,177 (80%) were unnecessary and included for analysis. 3.8% of unnecessary prescriptions were associated with an AAE; primary and secondary endpoints are listed in the Table. ED visits (1.2%) and new allergies (2.9%) were most frequent. Clindamycin was associated with more AAE than amoxicillin (risk difference 322.1 per 1000 person-years, 95% CI: 238.5 - 405.8). Conclusion Even though antibiotic prophylaxis is prescribed for a short duration (≤2 days), it is not without risk. Since most AAE are diagnosed in medical settings, dentists may not be aware of these adverse effects. These data provide further impetus to decrease unnecessary prescribing of antibiotic prophylaxis prior to dental procedures. Disclosures All Authors: No reported Disclosures.

Key Points Question How do opioid prescribing patterns differ between dentists in the United States and dentists in England? Findings In this cross-sectional study of opioid prescribing by dentists in 2016, the proportion of dental prescriptions that were opioids was 37 times greater in the United States than in England. Meaning In light of similar oral health and dentist use between the 2 countries, it is likely that opioid prescribing by US dentists is excessive and could be reduced., This cross-sectional study compares the rate of opioid prescriptions by dentists dispensed from outpatient pharmacies and health care settings in the United States and England in 2016., Importance The United States consumes most of the opioids worldwide despite representing a small portion of the world’s population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries. Objective To compare opioid prescribing by dentists in the United States and England. Design, Setting, and Participants Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019. Exposures Opioids prescribed by dentists. Main Outcomes and Measures Proportion and prescribing rates of opioid prescriptions. Results In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P

Background Antibiotics are recommended prior to certain dental procedures (“antibiotic prophylaxis”) in patients with select comorbidities to prevent serious distant site infections. Our objective was to assess the appropriateness of antibiotic prophylaxis by dentists using Truven, a national integrated medical, dental, and prescription (Rx) claims database of 350 commercial plans. Methods Cross-sectional study of 8.7 million adult dental visits in 2015. Antibiotic prophylaxis was defined as Rx with Results In 2015, 30,726 antibiotics were prescribed for dental infection prophylaxis for 21,986 patients (mean age=58.6 + 15.0 years; 55.9% female). Amoxicillin (68.5%) and clindamycin (14.7%) were most common. 29,879 dental visits were associated with 69,639 dental codes ([CDTs]; range 1–14 CDTs/visit). Most dental visits were diagnostic (65.9% of visits with >1 diagnostic CDT), preventative (53.0%), and restorative (11.2%). 98.4% of dental visits had an appropriate CDT for antibiotic prophylaxis. Comorbidities include orthopedic implants (45.4%) and cardiac diagnoses at the highest risk of infective endocarditis (22.2%). Per guidelines, 78.0% of dental visits with antibiotic prophylaxis were inappropriate. Amoxicillin was more likely to be inappropriate than other agents (OR=1.65; 95% CI: 1.55–1.76). Orthopedic implants (OR=3.35; 95% CI: 3.14–3.56), tooth implant procedures (OR=3.30; 95% CI: 2.48–4.39), females (OR=1.35; 95% CI: 1.27–1.43) and the western US (OR=1.22; 95% CI: 1.09–1.36) were associated with inappropriate prescribing. Conclusion Antibiotic prophylaxis is prescribed for indicated dental procedures, but is not appropriately limited to patients with cardiac diagnoses per guidelines. Implementing antimicrobial stewardship efforts in dental practices may be an opportunity to improve antibiotic prescribing for infection prophylaxis. Disclosures J. C. McGregor, Merck: Grant Investigator, Research grant.